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How Community-Based Doulas Are Working to End Racial Disparities in Maternal Health

Updated: Feb 24, 2023



It’s no secret women’s health is not well-researched or funded. It’s also well known that there are inequities within women’s health – specifically, between Black and white women. As a doula and birthing professional with years of experience, I’ve seen this firsthand.


The statistics when it comes to maternal care are shocking.


The hard truth is, Black women are three times more likely to die from a pregnancy-related complication than white women.1


The cause of this difference is due to lack of access to healthcare, implicit bias, and of course, structural racism. Black women do not have the same resources to specialists, doulas, and financial assistance – for many reasons.


Yet, all of the answers lead back to racism.


Additionally, when Black women do get access to care their concerns are often minimized, putting them in life-threatening situations. It’s become a deadly cycle.


Not only is this unacceptable, but it’s preventable. No woman should have to die in childbirth, especially if their issue is treatable through proper care.


So, how do we create access to and support more equity within Black women’s maternal health?


First, we acknowledge the issue. Then we demand proper care.


We do this by holding space to reflect on and acknowledge the ways in which we have been feeding into white supremacy culture. White supremacy is not new. It’s been around from the very start, due to colonization. It’s just one of the trickle-down effects of the way we started this country through enslaved people.


As a society, we need to take full ownership of this lack of care for black women and Black lives.


Once we accept this truth we can work together to uproot racism in healthcare – discovering and removing the blinders that are causing Black women and their children their lives. This is how we properly support Black women through their journey into motherhood.


One way to help Black pregnant women in the healthcare system? Implement universal doula care.


Communities that offer doula care to Black mothers are seeing an increase in healthy pregnancies and births in Black mothers. 2


While this is a step in the right direction, more must be done for Black mothers to survive birth and thrive in their motherhood journey.


What Is a Doula?

Midwives and doulas have been around for centuries. Up until about 100 years ago, when hospitals became more popular for childbirth, midwives and doulas were the primary support to pregnant women.


Yet, there is a significant difference between a doula and a midwife. A doula is someone who is skilled and provides emotional, mental, and physical support to mothers before, during, and after the birth or loss of a child. A midwife has formal obstetrics training in labor and delivery and is able to perform medical tasks.


Over the course of history, doulas and midwives have provided women with essential care during pregnancy and childbirth.


In fact, when hospitals would not accept Black pregnant mothers to deliver at their facilities, it was the midwives and doulas who filled the health gap – especially in the south. This gap between accessible hospital care between white and Black mothers gave way to the granny midwife. Granny midwives were well-respected Black women who provided care in their community in the form of midwifery, lactation consultants, nutritionists, postpartum doula, and all-around care for new mothers. 3


Doulas have always been a staple in certain cultures and communities, yet with the advent of hospitals and science, more and more pregnant mothers rely on just one doctor – their OB/GYN.


While this is a great choice for some women, we can not overlook the importance of doula care, especially in underserved communities.


Doulas bridge the care between doctor visits and hold space for pregnant women's emotional and mental journey. Doulas also provide valuable local resources to mothers and families throughout their parenting and birthing period. More than ever, I’ve found women are yearning for better care in their pregnancy journey.


Since the pandemic and the continued horrid maternal death rates in Black pregnant women, we are seeing a resurgence in community-based doulas. This is one step forward in helping black mothers and saving their lives.



Doulas and Black Maternal Mortality

In order to improve Black mothers' care, we need to address the immediate and long-term changes that need to happen in the healthcare field.


Actively supporting Black mothers' health and their baby’s health is the first step. This goes beyond awareness and talking. This needs action.


Aligning with organizations that are introducing policies that help Black mothers is a step in the right direction. Organizations such as Black Women’s Health Imperative are creating and advocating for policy changes that will improve the healthcare Black mothers receive and decrease Black maternal mortality rates.


Unfortunately, policies and bills take time to approve. Black pregnant mothers don’t have the luxury of waiting when their lives are on the line.


This is why the implementation of community-based doulas is so crucial to Black mothers. In the past, doulas have been compensated out of pocket by the pregnant mother. This added expense can be a hardship for many women that don’t have the budget to hire outside care.


To acknowledge the equity gap between white and Black pregnant women's care, some healthcare providers are taking steps to improve Black mothers' morbidity rates.


Recently, Blue Shield of California launched a new program that provides doula to Black and brown communities. This pilot program addresses the need to fill in the holes in the healthcare system by using community-based doulas.


“We knew we couldn’t erase disparities or provide services on our own.”

—Shannon Cosgrove, Blue Shield Director of Community Health.


This pilot program started in areas of California where there were the highest infant mortality rates and birth complications. Working alongside organizations that focus on Black mothers, this program offers their doula services free of charge. 4


So far, the doula-implemented program has shown successful results in the areas they’re servicing. On average, Black mothers receiving doula care have had more full-term births, less postpartum depression, and a decrease in cesarean sections.


Additionally, Medi-Cal launched a program this year to offer full spectrum perinatal support. This program is specifically aimed at Black and Brown women to improve the maternal morbidity rate and health outcomes.5


Here in Washington state, our leaders are creating ways to help Black mothers by recognizing the importance of doula care. House bill 1881 passed in 2022 states that –


“In collaboration with community partners who advance 17 equitable access to improve perinatal outcomes and care through 18 holistic services for Black and Brown communities, adopt rules 19 establishing the competency-based requirements that a birth doula 20 must meet to obtain certification.”6


Overall, this new legislature will help more Black and Brown women throughout their birth journey by creating more individualized care and support.


Yet, in order for there to be lasting positive effects, there needs to be change implemented in the micro and macro parts of our society.


This can only happen by implementing anti-racist work in our daily lives, taking responsibility for the issue as a society, and consistently championing new legislation and funding for Black mothers.


The Importance of Community and Doulas

It’s important for me to not only align myself with people and organizations but to create a brave space for women to receive the health they need.


As a doula based in Washington state, I’ve helped numerous women on their journey into motherhood. It is one of my greatest joys and life’s work to provide families with individualized support and care during such an intimate time in their lives.


Having a doula is something that every woman should have access to. That is why I take it on as my responsibility to increase equity, inclusion, and information for both caregivers and future parents.


It’s with this thought and dream that I created a unique community. A group full of people just like you.


The Modern Village Community is a brave and collaborative space for parents, caregivers, and professionals to join together and bridge the gap in family care.


Together we share our knowledge, offer advice, and provide tools to help you on your journey.


When you join the Modern Village Community, you’ll receive your own FREE 4th-trimester toolkit. It’s full of expert tips and advice (from a certified and experienced doula) for every question you may have on your journey into parenthood.


If you’re ready to find your village, receive support, and start creating spaces for all people to thrive, then join me in making a change in your life and the lives around you.


I can’t wait to see what we accomplish together.


So, what are you waiting for? Join here.





Resources

1. Working Together to Reduce Black Maternal Mortality, CDC. April 6,2022


2. Gourley, Kristin. Data Show Community-Based Doulas Improve Outcomes for Black Mothers, Blue Cross Blue Shield. April 11, 2022


3. In Honor of Black History Month We Spotlight the Granny Midwives and Their Legacy, Alameda Health System. February 9, 2021


4. Gourley, Kristin. Data Show Community-Based Doulas Improve Outcomes for Black Mothers, Blue Cross Blue Shield. April 11, 2022


5. Quick Guide to Medi-Cal Coverage of Doula Services, Black Wellness and Prosperity Center. December 27,2022


6. Law Files, CERTIFICATION OF ENROLLMENT ENGROSSED SUBSTITUTE HOUSE BILL 1881 https://lawfilesext.leg.wa.gov/biennium/2021-22/Pdf/Bills/Session%20Laws/House/1881-S.SL.pdf?q=20220707124501


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